This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.

Sunday, March 04, 2012

Tamarins, Ewoks, and people

When I was appointed Executive Dean for Administration at Harvard Medical School in 1998, I learned for the first time of the existence of the New England Primate Center. One of eight such centers in the US, this is a home to several types of monkeys that are used for medical research. The value of such research is uncontroverted, but the facilities like to stay in the background because they have been the targets, literally and figuratively, of animal rights advocates who believe they should be shut down.

So, it was bad news recently for the New England center when it was disclosed that a number of their cotton top tamarin monkeys had died from improper treatment. I remember these monkeys well. They had been collected from the forests of Colombia. In 1973 the species was declared endangered and importation was banned. As reported on this website:

Current population numbers are unknown, but more than 3/4 of its original habitat has been deforested, much of it for cattle pasture. Remnant populations are small and are restricted to a few isolated forest fragments. Currently, deforestation for agriculture, fuel, and housing is the greatest threat to the survival of the cotton-top tamarin.

The "endangered" designation meant that the researchers in the primate centers could no longer kill the monkeys for purposes of medical research. As I recall, the only research that was permitted was about colitis, which is a naturally occurring medical problem for these monkeys. Because of the monkeys' statutory protection, primate centers became breeding centers for the tamarins. In captivity, females can give birth to twins every 28 weeks. So, the primate centers often looked for other places, like zoos, to send them.

I think the zoos like them because they are cute and adorable, and perhaps because they look somewhat like Ewoks from Star Wars. It is all too easy to anthropomorphize them, as you see in this report from the NEW Zoo in Wisconsin:

“Bonnie was sent here to join Clyde in 2007 and the two hit it off instantly!”, remarked Murach. “They have been a closely bonded couple ever since. In 2010 the SSP (Species Survival Plans) asked that they start a family and they were happy to comply. The young tamarins were born the day after Christmas and after a few weeks of privacy are ready to meet the world!”

It goes without question that the primate centers owe a duty of care to the animals in their possession, and it appears from the news reports that such was lacking in Southborough. The result, though, was striking. Here's the story, as reported by Carolyn Johnson in the Boston Globe:

The interim director of Harvard’s New England Primate Research Center, appointed in September to address problems at the animal research facility, resigned from the position yesterday after the death Sunday of a monkey that was found in poor condition in a cage without a water bottle.

It was the third death in Dr. Fred Wang’s short tenure as head of the facility in Southborough and the fourth there since June 2010.

In a statement, Wang said that he decided to resign “for personal and professional reasons, despite the strong requests from Harvard Medical School to continue.’’

Why is this striking? Because of the contrast with the situation in human medical facilities. There, senior administrators feel no guilt and have been granted virtual impunity in the face of preventable fatalities. Boards of trustees routinely fail to hold leadership accountable for making quality and safety improvements a priority in their hospitals. Most boards do not even try to govern this aspect of hospital operations. How, in the face of 100,000 preventable deaths per year -- equivalent to a full Boeing 727 crashing every day -- can the lay and professional leadership of so many hospitals turn their backs on this issue?

7 comments:

Anonymous
said...

Good point, Paul. I was outraged about the cage with no water bottle, and then thought, wait - what about the human patient in bed with the infiltrated IV line, or given the wrong medication, or the alarm sounding with no response? Those conditions are directly analogous to the monkey with no water bottle.

The legal system will not be changed, but it does not have to be changed to accomplish that goal. Many places have figured out how to work within the malpractice legal environment to incorporate transparency and process improvement.

I agree with that and we are working on it with QA and RCA. Much better than when I started in 1971 when the docs closed ranks on the poor performers and covered up the mistakes. Still trying to put patients first!

Thanks for an interesting post. The neglect that is occurring at the New England Primate Center is inexcusable. Likewise, the neglect and sub-par care that I've seen poor people receive in our nation's medical offices and hospitals also is inexcusable. (My own grandmother, a poor and uneducated woman in rural Kentucky, died as the result of being given two incompatible drugs and sent home after seeking treatment in the emergency room for a migraine one weekend.) Both human and animal neglect, in my mind, are symptomatic of a larger problem in our society. In my mind, the anthropomorphism you mention is not a bad thing at all. It serves to remind us that we're not as different from animals as we would like to believe. (Alas, humans ARE animals!) It also may one day help us to realize that human health is linked inextricably to that of non-human animals and the environment.

We must take every death of humans and tamarins (as well as all other animals in medical laboratories) very seriously. Most people give absolutely no thought to how many rabbits, rats, Beagles, monkeys, chimpanzees, and other animals suffered (and sometimes were killed) in order for us humans to have various drugs or medical procedures (not to mention frivolous things like make-up and household products) available to us.

I believe that we must continue to develop alternatives to animal models not only because it's ethically sound to do so but because the research findings from rats and even chimpanzees are not always predictive of how a drug is going to behave in a human body. Amazing scientists at places like the Johns Hopkins Center for Alternatives to Animal Testing and at the Physicians Committee for Responsible Medicine - not to mention Organovo - are committed to finding such alternatives. I also believe that I have a moral obligation as a human being to volunteer for medical studies. Likewise, we all have an obligation as citizens of this country to raise the issues of patient neglect and death with our legislators, hospital administrators, and healthcare providers. Perhaps we can even volunteer to serve as a patient advocate for someone who doesn't have the ability (or English language skills) to advocate for him or herself in health matters.

The bottom line? Unless those of us who are keenly aware of these issues of human and animal mistreatment and neglect make a point of raising those issues time and time again until something changes, we're just as guilty as Fred Wang. We can not afford to turn a blind eye, and I thank you for being a constant reminder of what must change in our nation's hospitals.

Why can't they do tests on people? There are many willing participants in pain or with life threatening illnesses. It's not the cuteness of the animals, but the fact that they are taken unwillingly and subjected to many torturous activities. The double standard is that you can't test on people first.